Month eight
Conquering the fear of birth
“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.