Month eight

Con­quer­ing the fear of birth

Your Pregnancy - - Contents -

“I HAD A VERY

trau­ma­tis­ing birth ex­pe­ri­ence with my first baby, and when I dis­cov­ered I was preg­nant for the sec­ond time, I had an al­most over­whelm­ing dread of what was go­ing to hap­pen at the end of the preg­nancy,” says 32-year-old Louelle Matheba. “Be­cause I knew that baby would have to come out, one way or an­other.” Louelle falls into a sig­nif­i­cant per­cent­age of women who feel over­come with ter­ror of giv­ing birth; for some women, the pho­bia is so in­tense that they may in­sist on hav­ing an abor­tion if they find they’re preg­nant, or they ab­stain from sex al­to­gether or even opt for an elec­tive hys­terec­tomy.

WHAT IS TOKO­PHO­BIA?

Called “toko­pho­bia” (tokos is Greek for “child­birth”), the de­bil­i­tat­ing fear of giv­ing birth is a rel­a­tively newly recog­nised and stud­ied con­di­tion – it was only for­mally in­tro­duced into med­i­cal lit­er­a­ture in 2000. “Some women’s fear is not sim­ply the birth, but the hor­ror of hav­ing an­other be­ing in­side them or of split­ting in two,” Mau­reen Tread­well, co­founder of the Birth Trauma As­so­ci­a­tion, told the In­de­pen­dent on­line (in­de­pen­dent.co.uk) in Jan­uary. “We’ve had cases where women have ended up in psy­chi­atric units be­cause they’re so afraid.”

WHO EX­PE­RI­ENCES TOKO­PHO­BIA?

Like so many other phobias, there doesn’t nec­es­sar­ily have to be a trig­ger for a woman to have a ter­ri­ble fear of child­birth. Th­ese “pri­mary” suf­fer­ers have no ra­tio­nal ba­sis for their fears. Some women re­port know­ing from a very early age – toko­pho­bia of­ten de­vel­ops in early ado­les­cence – that they will never have chil­dren be­cause of the pho­bia. And it’s not as rare as some may think – ac­cord­ing to a 2012 study in the Industrial Psy­chi­a­try Jour­nal, up to 13 per­cent of women ex­pe­ri­ence toko­pho­bia strong enough to dis­suade them from ever hav­ing chil­dren. “Se­condary” toko­pho­bics may de­velop the fear as a re­sult of a prob­lem­atic or very painful birth (such as Louelle’s), a mis­car­riage or a still­birth, or sim­ply hear­ing neg­a­tive sto­ries or watch­ing pro­grammes de­pict­ing shock­ing birth ex­pe­ri­ences. Some women’s toko­pho­bia is a re­sult of their be­ing afraid of dy­ing in child­birth – which, in South Africa, is a very real fear. A 2014 re­port re­leased by the South African Med­i­cal Re­search

Coun­cil gives a ma­ter­nal mor­tal­ity rate of 197 deaths per 100 000 live births for 2011. Com­pare this to a ma­ter­nal mor­tal­ity ra­tio of 14 ma­ter­nal deaths for ev­ery 100 000 live births in the United States, and the prob­lem be­comes very clear.

WHAT CAN TOKO­PHO­BICS DO TO EASE THE SYMP­TOMS?

“Know­ing the source of the fear helps in know­ing whether it’s some­thing that needs to be ‘un­learnt’ or be dealt with through deeper psy­chother­apy,” says clin­i­cal psy­chol­o­gist Than­dazile Mtetwa, who prac­tises at Ngezwi Psy­cho­log­i­cal Ser­vices in Gaut­eng. She ad­vises women ex­pe­ri­enc­ing thoko­pho­bia to get pro­fes­sional help. “The meth­ods used in ther­apy will dif­fer widely, depend­ing on the source of the fear.” Be­cause thoko­pho­bia may neg­a­tively af­fect the labour process, al­ter­na­tive de­liv­ery meth­ods may be ad­vis­able. “The woman may freeze up and be un­co­op­er­a­tive in labour, not be­cause she doesn’t want to co­op­er­ate but be­cause she’s paral­ysed by fear,” Mtetwa ex­plains. “This may not only put the child in dan­ger but fur­ther trau­ma­tise the mother, and in th­ese cases it may be bet­ter to de­liver via cae­sarean sec­tion.” Some women say that hyp­nother­apy helps. There are many on­line sup­port groups, in­clud­ing sev­eral Face­book pages, for women with thoko­pho­bia. Th­ese will help women un­der­stand that they’re not alone or “freaks of na­ture”. “Fear­ful or anx­ious preg­nant women will ben­e­fit from a well-in­formed sup­port sys­tem – a mother, friend or mid­wife – who will be able to al­lay their fears rather than fuel them,” Mtetwa adds. In Louelle’s case, she had a very sym­pa­thetic and sup­port­ive gy­nae­col­o­gist, who fully un­der­stood her ter­ror. “With­out pres­sur­ing me in any way, she agreed to al­low me to have an elec­tive C-sec­tion. My daugh­ter was born with­out any drama. It was a huge relief,” she says.

A 2016 study pub­lished in the Jour­nal of Ob­stet­ric, Gyne­co­logic and Neona­tal Nurs­ing re­vealed that women who have sig­nif­i­cant fear of child­birth are more likely to suf­fer from post­na­tal de­pres­sion.

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