From pregnancy to childbirth
The pregnancy and the birth of a child are commonly seen as among the most beautiful and intense moments of one’s life. However, especially for the woman, these require a remarkable physical, psychological and social adaptation.
Become mothers requires learning new skills and the increase in responsibility. It represents one of the most significant transition phases of adult life.
During the first quarter many physical symptoms often present themselves (nausea, tiredness, pain) and thoughts focus mainly on themselves. I hardly take over the fear of childbirth (also called tocophobia).
In the second quarter, awareness of the movements of the child and the emotions deriving from the realization of the fetus as an independent individual begins to emerge. The woman begins to savor the concept of motherhood and adapts to the innerized conceptions of parenting. Anxiety is often experienced unaware in the first quarter. Then it is replaced by more specific concerns about the child and practical preparation of the things that will serve after birth. This phase is usually full of positive energy (Rouhe, 2015).
The last quarter of pregnancy is a moment of Preparation for childbirth in which the interest in surrounding situations is reduced. There is a greater concentration on birth. Thus were also born the Anxieties and fears for childbirth same. With childbirth, the woman prepares to “loosen” the symbiotic relationship formed in pregnancy with the fetus and give its partner the space to create the relationship with the child (Rouhe, 2015).
Symptoms of fear of childbirth
There fear of childbirth or tocophobia It causes intense anxiety, suffering or terror that develops during pregnancy and is characterized by “avoidance” of childbirth. According to studies from 5% to 16% of pregnant women suffer from this specific phobic state (Adams et al., 2012).
In clinical practice, the childbirth phobia It is mainly self-refined and there are no guidelines or diagnostic criteria to evaluate it. In some cases this phobic state is serious, causing anxiety, physical disorders and nightmares during pregnancy. There tocophobia leads to avoid facing the feared event, or natural birth. Those who have this fear often want to give birth with cesarean cut or requires help to pour out this specific fear.
Each childbirth involves a risk for both the mother and the child, although the risk is very small in western countries. In fact, morbidity is much higher in the cesarean parts than the natural parts (Rouhe 2011).
There fear of pain During labor, it seems to be strongly associated with fear of pain in general. It is one of the most common reasons underlying the cesarean cut request in those who have fear of childbirth. This can therefore be seen in this sense as a pain avoidance behavior.
Fear of primary and secondary birth
In literature the tocophobia It can be distinguished in primary tocophobia and secondary tocophobia. The first is characterized by a terror and an intense suffering for childbirth before conception. The second condition is found mainly as a result of previous traumatic experiences related to childbirth.
For example, conditions such as having a complex and prolonged labor, the need for invasive obstetric maneuvers, or an emergency cesarean cut carried out in critical conditions. The perception by the partorient of having undergone violence on one’s body can represent a risk factor. This also in the event that the birth has had a regular course. In some cases it can determine a post-traumatic stress disorder or Post-partum depression.
Who suffers from tocophobia
There fear of childbirth It seems to be associated with personality inclined to anxiety, more vulnerable, with low self -esteem and a history of traumatic events. But there are also contradictory results on mental health problems in women with such fear (Jokic-Begic N. et al. 2014). Some studies have shown the connection between tocophobia and mental health problems, such as depression, anxiety disorders And eating disorders. However, there are also results that suggest that only a small part of fear is related to anxiety and depression.
There fear of childbirth It seems to be in relation to factors such as:
- the fear and distrust about the skills and skills of the obstetric staff
- the fear of pain and the fear of losing control associated with the event
- The fear of dying during childbirth or that his child dates (Sjögren, 1997).
Obstetric complications and fear of dying are significantly related to tocophobia. In literature they are documented how some women come to resort to voluntary termination for pregnancy for fear of childbirth. This especially following a traumatic birth event.
The social and cultural background relating to fear of childbirth It often includes terrific stories or negative experiences related to childbirth, told by friends, relatives or read on forums or contacts found on the Internet.
Sometimes women with tocophobia They were traumatized during childhood by childbirth experiences reported by their mothers or acquaintances.
Even sexual abuse, physical and emotional immediately by the woman during childhood or adolescence seems to be common in those who present childbirth fears. Abused women seem to request more the cesarean cut than the general population and often symptoms of tocophobia with consequent avoidance.
Prevention and care of the fear of childbirth
Numerous studies have shown how support and social support, in addition to the emotional one, constitute protective factors for pregnant women and for the tocophobia.
Good support from the partner is significant during pregnancy and childbirth. If the partner is depressed, the woman will also present depressive symptoms more likely. In addition, marital problems or being a single mother represent risk factors for post-natal depression.
From a treatment point of view, it is possible to first think of the importance of primary and secondary prevention interventions. Psycho-education interventions, relaxation and individual cognitive psychotherapy and psychotherapy are also useful.
The training of operators who work with the woman in the various phases of accompanying maternity allows to identify those who could develop the fear of childbirth and intervene early on symptoms. In addition, effective and clear communication from medical staff allows you to help the woman to be more aware and increase their perception of control.
BIBLIOGRAPHY
- Adams, SS, Eberhrd-Gran, M., & Elskild, A. (2012). Fear of Childbirth and Duration of Labor: A Study of 2206 Women intended Vaginal Delivery, Bjog: An International Journal of Obsthetics and Gynaecology119 (10), 1238-1246.
- Jokic-Begic N., Zigic L., Nakic Rados S. (2014). Anxiety and Anxiety Sensititità As Predicortors of Fear of Childbirth: Different Patterns for Nulliparous and Parous Women. Journal of Psychosomatic Obtetrics Gynecology 35: 22-28.
- Sjogren B. (1997). Reasons for Anxiety about Childbirth in 100 Pregnant Women. Journal of Psychosomatic Obtetics and Gynecology; 18, 266-72.
- Rouhe, H. (2011) Should Women Be Able to Request in Caesarean Section? No. BMJ 2011; 343: 7565
- Rouhe, H. (2015). Fear of Childbirth. Academic dissertation. Department of Obstitrics and Gynaecology Helsinki University Hospital.
