A history of depression, rape or sexual abuse, or trauma from too-graphicimages of childbirth, may result in tokophobia, reports Anne Dempsey
The fact that women are postponing or vetoing motherhood these days has been ascribed to everything from career success to the cost of urban housing. But now the British Journal of Psychiatry has come up with another major factor - tokophobia, or fear of childbirth.
New research suggests that as many as one in seven women suffers from either primary tokophobia, which develops in adolescence, or a secondary type occurring after a traumatic delivery. Women most at risk include those with a history of depression, rape or sexual abuse, or affected badly by too-graphic educational videos of childbirth.
Dr Siobhan Barry who is consultant psychiatrist with the Cluain Mhuire Service, says the small numbers of women she sees with tokophobia fall into two categories.
"First would be those who have never had a pregnancy or delivery and are extremely frightened at the prospect. In some cases they are anxious by nature. Then if a woman has been misused sexually, fear of childbirth is just part of a much wider fear which would involve being examined, looked at, and this could be so great so as to prevent her from becoming pregnant in the first place.
"The second group would have had such a traumatic delivery that they are almost suffering from Post Traumatic Stress Disorder. They may have suffered a lot of pain, have presented too late for an epidural, had back problems making it difficult to give epidural, or had a large baby and suffered first-degree tear. I may see them when they are expecting again and terrified of a repeat. Reassuring them can be difficult because they know what they've been through."
Our expectations have changed also, says Barry. Women have more control over their lives and bodies now, but birth still involves a very primitive surrender.
How can fearful women be reassured? "It depends on whether it is primary or secondary situation," says Barry. "If she is highly anxious after a previous bad experience, I would be talking to her and her obstetrician, and we may discuss an elective Caesarean. For first-time mothers, we would be giving as much support as we could, explaining what will happen and discussing pain relief. This is a very important current issue. It is now being recognised that high maternal anxiety levels can contribute to low birth weight, which means that this is something we must address."
Elaine suffered a lot of childhood illness which left her with a fear of hospitals and a need to be in as much control of her own life as possible. Now in a loving relationship for four years, she becomes panicky when her partner talks about marriage and children.
"I tend to kick for touch and say what's the hurry? I'm not being fair to him and it's something I will have to face. I would like a baby, yes I would, but I feel as if I have to climb a huge mountain and go through something huge to have a child. It seems like a big invasion which would take me over and it fills me with fear."
While true tokophobics may be relatively rare, women seem to be increasingly anxious about childbirth, due perhaps to growing up in smaller families and being less exposed to babies.
Elma O'Sullivan is an ante-natal teacher with the Irish Childbirth Trust in Cork. "We get women with a lot of fear, particularly first-timers facing the unknown, or women with a personal history of trauma such as a stillbirth. Many such fears are normal and we acknowledge what a big deal becoming a parent is.
"There is documentary evidence that many women go through a stage fright at 34-36 weeksbefore they go on to more acceptance. The ante-natal classes deal with the personal rather than the medical side of childbirth, allowing women, and couples, to talk through things and ask whatever questions they have."
Wife and husband Eilín Ní Riordáin and Bruce du Fre are holistic health practitioners with clinics in Dublin, Galway and Athlone. When Eilín was having her first child at the age of 37, she used acupuncture and homeopathic remedies for a natural birth.
"There were complications and without our holistic approach, it could have meant a Caesarean section," she says.
Resulting local publicity brought women to their practice with reproductive health issues, and they treat women for infertility and tokophobia.
"I would regularly see women who are terrified of childbirth. It can come up when you are taking a history, ask if they have children and hear a very heartfelt 'oh no!'. There are women in their 40s who say they were always too scared to have children, and younger women who say they are not going there. The tragedy is that some are very fond of children and would make very good mothers.
"Acupuncture can be very helpful. I might also prescribe homeopathic therapies such as gelsemium for performance, the Bach remedy Walnut, which deals with change, or a Rescue Remedy. Organs in play at this time are the kidney and spleen: if a woman is stressed, her energy in these areas is low, so I would give her exercises to bring her back to a place of belief, energy and power. I also find breathing exercises can be very helpful."