To truly understand anxiety disorders associated with childbirth it is important to explore the origins of these fears and anxieties. I feel the foundations for these can be viewed as falling into three themes: 1: loss or lack of control 2: negative expectations and 3: physical and mental distress. Birth is a universal experience existing since the very beginning of evolution, but for some the thought of birthing their baby evokes overwhelming feelings of fear and anxiety. At its most debilitation tokophobia, intense fear child birth, can be diagnosed. Anxiety disorders associated with childbirth, their origins and effects will be explored taking into account the many degrees of anxiety and their response to hypnosis.
The term tokophobia was first used to describe an intense anxiety and fear of childbirth in 2000 by Hofberg and Brockington. A degree of fear of childbirth is fairly common, over 20% of pregnant women report fear, 6% describe a fear that is disabling and 13% of women who have not become pregnant report fear of childbirth sufficient to postpone or avoid pregnancy. Other studies have shown much higher rates of fear in pregnant women . It is now widely accepted that pregnancy may be a time of considerable anxiety with symptoms worsening in the third trimester .
There were four significant aspects to tokophobia; intense anxiety and worry about childbirth; difficulties controlling this concern; difficulty concentrating on work and family activities; plus at least three of the following symptoms: fear of pain, fear of being unable to give birth, physical disorders, nightmares, avoidance of pregnancy or request for caesarean section. It is clear from this definition that tokophobia is relevant throughout the pregnancy, birth and postnatally. Tokophobia can be present before any pregnancies (primary), developed after a birth (secondary) or as a result of more underlying psychological disorders.
Tokophobia could be seen as a condition at the top of the continuum of anxiety related to childbirth. Women and men can experience anxiety at many levels from mild anxiety that fluctuates and recedes right through to tokophobia. A study in 2002 involving 329 pregnant women in Finland found that 78% expressed fears relating to pregnancy, childbirth, or both. This suggests, therefore, that anxiety and fear are experienced by the majority of women to some degree. Any level of anxiety or fear in pregnancy has the potential to affect the woman, baby and wider family. Dick-Reid (2013) goes as far as to state that fear of childbirth over many generations has had a growing negative effect on civilisations all over the world.
The movement of birth into hospitals began in the Seventeenth century in France when male doctors first stepped into the birthing environment. This marked the start of the removal of power and expertise in the birthing process from the women herself. By removing the birthing woman’s sense of control and introducing many processes and techniques alien to her it is not difficult to see why fear and anxiety would increase.A study in 2008 found that lack of control featured as a cause of secondary tokophobia in all the women interviewed.
A reason for the profound negative influence of loss of control may be understood by looking at our psychological development as a whole. From our birth onwards we move toward a growing sense of control over our environment, our choices and daily life. It is simply human nature to want a slice of life that we can control and that when this control is threatened anxiety disorders can develop. When a sense of control is lost it can be replaced by a fear o terrible things happening which cannot be stopped . This has clear implications for the process of childbirth. A woman and potentially a man who perceives a lack of control may it seems easily move into experiencing fear and anxiety about the new journey they are embarking on.
An individual’s expectations of a forthcoming event will influence how they feel about it. There are many influences present on modern women’s expectations of childbirth and the proliferation of negative views on birth is widely recognised.
The role of negative expectations in the development of anxiety disorders associated with pregnancy cannot be underestimated. Dick-Reid (2013) highlights the many pronged attack of negative influence on pregnant women; involving the media, literature, friends, mothers and partners. Most importantly many of these negative frightening influences are from people who we hold as important and respected. This proves to strengthen the effects of their words, however well meaning. Research suggests that mothers who have unresolved trauma relating to birth can unintentionally pass this on to their daughters.
There is a growing recognition of the potential role that medical involvement has in the belief that birth is fearful and potentially dangerous and life threatening. The movement of birth to hospital settings, associated with illness and trauma, could feed women’s and societies belief that birth is dangerous. The manner in which women are led to believe medical or surgical intervention may be needed e.g. during antenatal checks, even before birth commences increases the perception that child birth is dangerous. An expectation that child birth is dangerous is a powerful foundation for anxiety associated with child birth.
The third theme relates to physical and mental distress. Most obviously this relates to the fear of physical pain during childbirth. A study in 2006 found that pain during contractions and pain during the passage of the baby from the vagina were both feared although some women feared only one of these. For some the fear of physical distress manifests as a fear of dying during child birth.
Mental distress can relate to many aspects of pregnancy, childbirth and the postnatal period. If mental distress is experienced then fear and anxiety can reasonably be expected to develop.
The origins of anxiety disorders associated with childbirth are clearly complex but an awareness of this allows both the effects of this anxiety, wherever it falls on the continuum, and potential ways to manage and reduce it to be understood.
If you are experiencing fear and anxiety during your pregnancy or even before becoming pregnant please do seek advise as you are not alone. Hypnobirthing is one way of lessening and managing this anxiety. Your midwife will also be able to offer you assistance. If you feel your fear and anxiety is affecting your life please do speak to your doctor for support.
Related pages : Hypnobirthing evidence.
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