![]() ![]() ![]() It is vital that the available options within the pathway are evidence based and reflect research findings presented in scientific peer reviewed journals. Women can be provided with opportunities to visit the birth environment and meet labour ward staff, develop a birth plan which includes decision making about how the baby will be born, and where necessary, engage in the necessary psychological interventions from a mental health team. Where a pathway of care is available, and timely referral is made, women are offered a clear plan of care for pregnancy and birth, they are provided with consistency of care, and have input from a specialist midwife. This has been shown to improve the experience of pregnancy, childbirth and the postpartum period significantly (NHS London Clinical Networks 2018). Anecdotal and research evidence indicates that women need timely referrals for treatment and support facilitated by a pathway of care. This process takes time, and it is vital that referrals are made in the earlier stages of pregnancy, in order to ensure that the work of the specialist services can make meaningful differences to the women’s condition. In areas where specialist services are available, women are referred by their midwife or obstetrician, for support and/or psychological treatment and to help coordinate their care. The aim of the referral is to help them to address the anxiety/fear in a supportive manner. Women with extreme disabling levels of fear warrant referral to specialist midwifery or perinatal mental health services. Not all women with tokophobia are pregnant women. There is the additional lack of clarity over whether these figures relate solely to pregnant women, or if they include women who have never entered maternity services due to the avoidance of pregnancy. Other studies referring to a ‘pathological and disabling fear of birth’ have used a range of 6-10% to highlight the prevalence (Kjærgaard et al, 2008 Searle et al, 1996). ![]() While rates in Western countries have been identified as over 20% (Demsar et al, 2018)), an Australian study has quoted a rate of 48% for moderate tokophobia and 26% for strong (Fenwick et al, 2009)). Whilst practitioners seem to be encountering women who are more able to talk about their fears, not all of these women will be recognised clinically as tokophobic, however a number of cases will require additional clinical support beyond that of routine maternity care.Īcross the fear of childbirth literature, there is a lack of consistency over the way tokophobia is defined, and this adds to a lack of clarity about prevalence rates. Practitioners have greater awareness of the impact of anxiety on pregnancy and childbirth and are more likely to encourage women during antenatal consultations, to discuss any fears or anxieties. This may be due to women feeling more able to report their fears. For some women, self-harm and suicide risk may increase as pregnancy progresses, and increasing proximity to delivery is associated with increasing anxiety. Risks to the baby/fetal risk include termination of pregnancy, potential difficulties with bonding and attachment and potential problems associated with on-going anxiety in pregnancy, such as the negative impact on emotional and developmental outcomes in the longer term (NHS London Clinical Networks, 2018).Ĭlinically, practitioners are encountering increasing numbers of women with varying levels of anxiety and fear about the prospect of giving birth. They have specific risks in relation to their clinical state, including severe levels of anxiety and depression and the risk of post-traumatic stress disorder (PTSD) (NHS London Clinical Networks, 2018). For those who do become pregnant, the condition can overshadow pregnancy and affect the choices they make for labour and birth. Some women will avoid pregnancy, even though they might want to have children. For some women, severe fear of childbirth can have debilitating effects. Catriona Jones, Faculty of Health Sciences, University of Hull of childbirth is conceptualised along a continuum, with women who are almost free of fear at one end, and women with severe or disabling fear (known as tokophobia) at the other. ![]()
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