Tokophobia – a multidisciplinary problem

Abstract

Pathological fear of childbirth known as “tokophobia” affects about 6-10% pregnancies and is of concern mainly because of remarkable sequele regarding women’s morbidity, the neurobehavioral development of their children, and cesarean section on maternal request (CSMR). Fear of labor is a multidimensional problem involving a number of biological, psychological and social background factors and may be divided into primary and secondary tokophobia and tokophobia as a symptom of depression. Fear of childbirth is closely related to the fear of labor pain. It appears that women who experience fear, suffer from more pain due to alterations in the mechanisms of pregnancy induced analgesia. Despite no relevant connection between tokophobia and request for effective analgesia for labor pain relief, neuraxial techniques should always be available, especially to women with increased levels of negative emotions. However, epidural analgesia itself may increase fear level at the end and after labor and delivery. The mainstay of tokphobia treatment constitutes psychotherapeutic methods, which decrease negative labor experience; their impact on CSMR is controversial. There is a strong need for multidisciplinary approach to tokophobia due to its complexity and obstetric, anesthesiological, psychological and psychiatric implications.