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Background: Anxiety disorders with a specific focus on fear of childbirth (FOC) are the most common mental health challenges in perinatal women. The accurate measurement of FOC is important for correctly identifying women with FOC, as well as for identifying the target population for treatment. We aimed to review FOC scales and evaluate their psychometric properties via the COSMIN methodology to identify the most suitable available instruments. Methods: We conducted this systematic review via a comprehensive search of databases, including PubMed, Web of Science, Scopus, Science Direct and ProQuest, to identify articles published from inception to May 2024 via combined keywords related to tools that assess FOC in women during pregnancy or postpartum period. The quality of the psychometric properties of the included studies was evaluated via the COSMIN checklist. Results: Of the 1160 records found initially, 47 articles were included in this review, 24 of which were related to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). According to the recommended categorization of the COSMIN methodology, among the 18 assessed scales, the Fear of Childbirth Questionnaire (FCQ) was categorized as A, and 11 scales, including the Fear-of-delivery Questionnaire (FDQ), W-DEQ-A & B, Delivery Fear Scale (DFS), Fear of Birth Scale (FOBS), Birth Anticipation Scale (BAS), Childbirth Fear Questionnaire (CFQ), Childbirth Fear Scale (CSF), Slade–Pais Expectations of Childbirth Scale (SPECS), and unnamed tools by Melender et al. (2005) and Eriksson et al. (2005) were categorized as B. Conclusion: According to the findings, the FCQ can be recommended for evaluating pregnant women with FOC. The measures categorized as B are potentially recommended for use, but further research is needed to evaluate the quality of this group. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Method Results Conclusion Reporting Method Impact Patient or Public Contribution To assess the prevalence of tokophobia (fear of childbirth) and evaluate the relationship between catastrophic thinking, tokophobia, childbirth preferences and the health profile of primigravida (first‐time pregnant women in rural areas).A descriptive correlational study.This study, implemented from January 2024 to March 2024, involved 300 primigravidae. Data collection was carried out using the Socio‐Demographic and Clinical Data Sheet, the Pain Catastrophising Scale (PCS) and the Fear of Childbirth Scale, which are specific tools chosen for their relevance to the research objectives.The mean score for catastrophic thinking is 36.13 (SD = 4.2740), which indicates a clinically significant level of pain catastrophising, and Tokophobia's mean is 42.53, which denotes intense Fear of Childbirth. There are strong positive correlations among catastrophic thinking and its subcomponents, positive correlations between tokophobia and devastating thinking and significant correlations between childbirth preferences and catastrophic thinking.This study's findings provide compelling insight into the intricate interplay between catastrophic thinking, tokophobia and childbirth preferences. These insights can pave the way for targeted psychological interventions to address catastrophic thinking in pregnant women, potentially alleviating tokophobia and supporting informed, less fear‐driven childbirth decisions. This could lead to a more positive childbirth experience for many birthing people, equipping healthcare professionals with actionable knowledge to improve maternal and child health outcomes.The relevant reporting method, that is, STROBE, has been adhered to.This study's findings have significant implications for the healthcare of pregnant women, particularly first‐time birthing people deemed high risk. The study suggests that thorough antenatal care can help ease their fear of childbirth, ultimately leading to improved outcomes for both women and babies.Public contribution by females in the community maternal services. [ABSTRACT FROM AUTHOR]

Background and AimMethodsResultsConclusionFear of childbirth is a common problem that affects women’s health and wellbeing. A variety of interventions have been used in research and clinical settings, but it remains unclear how interventions should be designed to be as effective and acceptable as possible. Additionally, the experiences of psychologists working to support women fearing childbirth are sparsely documented and therefore unavailable for researchers and clinicians. This qualitative study aimed to bridge this gap by exploring and describing the experiences of perinatal psychologists working clinically with women suffering from fear of childbirth.Focus group interviews with eleven psychologists, analysed with reflexive thematic analysis with an inductive and semantic approach.We identified four main themes, with three to four subthemes each. It was described as essential to meet the woman where she stands: to listen, validate, explore, and tailor interventions. Depending on the needs of each woman, the psychologists had a smorgasbord of core interventions to offer. They also described how they could help the woman and her partner or support person to prepare for childbirth. Finally, they addressed the importance of multiprofessional engagement and cooperation. A list of recommendations based on the findings is presented.The findings add to the existing literature on how to treat and support women with fear of childbirth and should be considered as one of many sources of information guiding the development of future interventions, care strategies, and clinical pathways for women fearing childbirth. [ABSTRACT FROM AUTHOR]

Introduction: Tokophobia is an intense and pathological fear of pregnancy and childbirth. Despite its significance, no research in Lebanon has investigated primary tokophobia within the general population. Nevertheless, it is crucial to assess the attitudes of both women and men, as potential future parents, towards pregnancy and childbirth, particularly during these challenging times for the Lebanese population. Therefore, this study aims to evaluate the psychometric properties of the Tokophobia Severity Scale (TSS) and Fathers' Fear of Childbirth Scale (FFCS) for assessing primary tokophobia among Lebanese nulliparous women and childless men, respectively. Methods: This cross-sectional investigation encompassed all Lebanese governorates; 651 women and 618 men were recruited via social media platforms, using a snowball sampling technique. The questionnaire included the Tokophobia Severity Scale, the Fathers' Fear of Childbirth Scale, the Patient Health Questionnaire, and the Lebanese Anxiety Scale. Results: Factorial analysis of the TSS in women revealed a three-factor model: concerns related to personal complications (Factor 1), fetal well-being (Factor 2), and outward behavioral responses to fear (Factor 3). The FFCS also yielded a three-factor measurement model: emotional responses during the partner's childbirth (Factor 1), concerns regarding the hospital environment during childbirth (Factor 2), and anxieties surrounding the perinatal health of both the partner and child (Factor 3). Both scales were internally consistent with Cronbach's alpha > 0.9, indicating their reliability. The TSS and FFCS demonstrated statistically significant correlations with measures of anxiety and depression, thus attesting to convergent validity. Conclusion: The results of this study provide evidence for the psychometric validity and reliability of the TSS and FFCS scales in Arabic-speaking populations. Given the previously overlooked nature of primary tokophobia in these populations, the availability of these validated instruments can significantly enhance the ability to detect and address this condition, ultimately facilitating the provision of necessary support services. [ABSTRACT FROM AUTHOR]

Abstract Background Anxiety disorders with a specific focus on fear of childbirth (FOC) are the most common mental health challenges in perinatal women. The accurate measurement of FOC is important for correctly identifying women with FOC, as well as for identifying the target population for treatment. We aimed to review FOC scales and evaluate their psychometric properties via the COSMIN methodology to identify the most suitable available instruments. Methods We conducted this systematic review via a comprehensive search of databases, including PubMed, Web of Science, Scopus, Science Direct and ProQuest, to identify articles published from inception to May 2024 via combined keywords related to tools that assess FOC in women during pregnancy or postpartum period. The quality of the psychometric properties of the included studies was evaluated via the COSMIN checklist. Results Of the 1160 records found initially, 47 articles were included in this review, 24 of which were related to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). According to the recommended categorization of the COSMIN methodology, among the 18 assessed scales, the Fear of Childbirth Questionnaire (FCQ) was categorized as A, and 11 scales, including the Fear-of-delivery Questionnaire (FDQ), W-DEQ-A & B, Delivery Fear Scale (DFS), Fear of Birth Scale (FOBS), Birth Anticipation Scale (BAS), Childbirth Fear Questionnaire (CFQ), Childbirth Fear Scale (CSF), Slade–Pais Expectations of Childbirth Scale (SPECS), and unnamed tools by Melender et al. (2005) and Eriksson et al. (2005) were categorized as B. Conclusion According to the findings, the FCQ can be recommended for evaluating pregnant women with FOC. The measures categorized as B are potentially recommended for use, but further research is needed to evaluate the quality of this group.

Abstract Introduction Tokophobia is an intense and pathological fear of pregnancy and childbirth. Despite its significance, no research in Lebanon has investigated primary tokophobia within the general population. Nevertheless, it is crucial to assess the attitudes of both women and men, as potential future parents, towards pregnancy and childbirth, particularly during these challenging times for the Lebanese population. Therefore, this study aims to evaluate the psychometric properties of the Tokophobia Severity Scale (TSS) and Fathers’ Fear of Childbirth Scale (FFCS) for assessing primary tokophobia among Lebanese nulliparous women and childless men, respectively. Methods This cross-sectional investigation encompassed all Lebanese governorates; 651 women and 618 men were recruited via social media platforms, using a snowball sampling technique. The questionnaire included the Tokophobia Severity Scale, the Fathers’ Fear of Childbirth Scale, the Patient Health Questionnaire, and the Lebanese Anxiety Scale. Results Factorial analysis of the TSS in women revealed a three-factor model: concerns related to personal complications (Factor 1), fetal well-being (Factor 2), and outward behavioral responses to fear (Factor 3). The FFCS also yielded a three-factor measurement model: emotional responses during the partner’s childbirth (Factor 1), concerns regarding the hospital environment during childbirth (Factor 2), and anxieties surrounding the perinatal health of both the partner and child (Factor 3). Both scales were internally consistent with Cronbach’s alpha > 0.9, indicating their reliability. The TSS and FFCS demonstrated statistically significant correlations with measures of anxiety and depression, thus attesting to convergent validity. Conclusion The results of this study provide evidence for the psychometric validity and reliability of the TSS and FFCS scales in Arabic-speaking populations. Given the previously overlooked nature of primary tokophobia in these populations, the availability of these validated instruments can significantly enhance the ability to detect and address this condition, ultimately facilitating the provision of necessary support services.

Copyright of Artuklu Health is the property of Mardin Artuklu University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pregnancy itself is a prerequisite for stress reactions. Even in the physiological course, pregnancy has a certain impact on a woman’s psyche, and some authors even consider it as a crisis situation or a “period of psychological uncertainty”. Women have different types of reactions to pregnancy: from the absence of any psychological problems to neurotic personality development. All the hardships of wartime affect not only the mother’s organism and her psychological state, but also the state of the unborn fetus, which is programmed with certain physical and mental health characteristics for the rest of its life. To prevent these negative effects, pregnant women during the pregravid period and gestation should take preventive measures aimed at strengthening the organism’s defense reactions in adverse conditions. These include a rational nutritious diet, determination of a woman’s personality type by a perinatal psychologist and appropriate psychological practices, and sufficient supplementation of important vitamins and minerals with antioxidant and other protective properties. Pregnancy under the influence of prolonged chronic stress can be complicated not only by purely obstetric and perinatal problems, but also by disorders of the formation of the labour dominant and preparatory processes in the cervix. As a result, this can lead to miscarriage due to the development of tokophobia as a psychological component of these disorders. Cervical maturation before childbirth is a multifactorial process that includes numerous elements, complex processes at the psychological, systemic, tissue, cellular, gene and molecular levels. Comprehensive preparation of a woman’s organism for childbirth in conditions of chronic stress and certain tokophobia (a woman’s fear of childbirth and uncertainty of the future for her and her child during the war) is not only about preventing stressful effects during pregnancy (magnesium complexes with B vitamins – up to the 36th week), conducting a complex of psychoprophylactic therapy and psychophysiological preparation for childbirth from the 37th week, but also in local impact on the cervical state, taking into account changes in connective tissue and correction of the infectious factor at the same time of pregnancy. For this purpose it is advisable and reasonable to prescribe vaginal suppositories based on hyaluronic acid (HA) to accelerate preparatory changes in the cervical tissues by stimulating the synthesis of its own HA and with antibacterial effects due to a complex of plant extracts. [ABSTRACT FROM AUTHOR]

Fear of childbirth (FOC), also referred to as tokophobia, can have detrimental consequences for a woman's well-being during pregnancy and for their subjective birth experience. However, it is unknown what role self-esteem plays in the relationship between FOC and the experience of childbirth. This study investigates the relation between FOC and the birth experience, and the role of self-esteem in that relation. We studied 125 nulliparous and parous Finnish women from their third trimester of pregnancy to 4–8 weeks postpartum. Path analysis with MLR estimation was conducted using MPlus to predict the childbirth experience according to prior self-esteem and fear of childbirth as well as their interaction. Also, age and parity were included as predictors of the birth experience, as well as their interactions with self-esteem. FOC was measured with the Wijma Delivery Expectancy/Experience Questionnaire – version A (W-DEQ-A), self-esteem with the Rosenberg Self-Esteem Scale (RSES), and birthing experience with the Delivery Satisfaction Scale (DSS). We found that self-esteem moderated the association between fear of childbirth and the subjective birth experience: the lower the self-esteem, the stronger the negative connection between FOC and the birth experience; and, reversely, the higher the self-esteem, the weaker the connection between FOC and the birth experience. The results highlight intra-group differences between fearful women and contribute to theory formation. They can be used in clinical practice and when planning interventions to reduce negative birth experiences. [ABSTRACT FROM AUTHOR]

Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year. There is mounting evidence to indicate that parents who develop childbirth-related posttraumatic stress disorder do so as a direct consequence of a traumatic childbirth experience. High-risk groups, such as those who experience preterm birth, stillbirth, or preeclampsia, have higher prevalence rates. The main risks include antenatal factors (eg, depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, history of trauma or sexual abuse, or mental health problems), perinatal factors (eg, negative subjective birth experience, operative birth, obstetrical complications, and severe maternal morbidity, as well as maternal near misses, lack of support, dissociation), and postpartum factors (eg, depression, postpartum physical complications, and poor coping and stress). The link between birth events and childbirth-related posttraumatic stress disorder provides a valuable opportunity to prevent traumatic childbirths and childbirth-related posttraumatic stress disorder from occurring in the first place. Childbirth-related posttraumatic stress disorder is an extremely distressing mental disorder and has a substantial negative impact on those who give birth, fathers or co-parents, and, potentially, the whole family. Still, a traumatic childbirth experience and childbirth-related posttraumatic stress disorder remain largely unrecognized in maternity services and are not routinely screened for during pregnancy and the postpartum period. In fact, there are gaps in the evidence on how, when, and who to screen. Similarly, there is a lack of evidence on how best to treat those affected. Primary prevention efforts (eg, screening for antenatal risk factors, use of trauma-informed care) are aimed at preventing a traumatic childbirth experience and childbirth-related posttraumatic stress disorder in the first place by eliminating or reducing risk factors for childbirth-related posttraumatic stress disorder. Secondary prevention approaches (eg, trauma-focused psychological therapies, early psychological interventions) aim to identify those who have had a traumatic childbirth experience and to intervene to prevent the development of childbirth-related posttraumatic stress disorder. Tertiary prevention (eg, trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing) seeks to ensure that people with childbirth-related posttraumatic stress disorder are identified and treated to recovery so that childbirth-related posttraumatic stress disorder does not become chronic. Adequate prevention, screening, and intervention could alleviate a considerable amount of suffering in affected families. In light of the available research on the impact of childbirth-related posttraumatic stress disorder on families, it is important to develop and evaluate assessment, prevention, and treatment interventions that target the birthing person, the couple dyad, the parent-infant dyad, and the family as a whole. Further research should focus on the inclusion of couples in different constellations and, more generally, on the inclusion of more diverse populations in diverse settings. The paucity of national and international policy guidance on the prevention, care, and treatment of psychological birth trauma and the lack of formal psychological birth trauma services and training, highlight the need to engage with service managers and policy makers. [ABSTRACT FROM AUTHOR]

The Fear of Childbirth (FOC) is regarded as a general problem, which affects women's health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies. This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers. In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021. After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly. According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth. [ABSTRACT FROM AUTHOR]

Background & Aims: Tokophobia is a pathological fear of childbirth that may impact the physical and mental well-being of both the mother and the infant (1). This condition can occur in pregnant and non-pregnant women, and even in men, and may be either primary or secondary, resulting from traumatic childbirth experiences or onset during adolescence (2). Women with tokophobia may face psychological issues, postpartum depression, and challenges in accepting specialized care for newborns during pregnancy (3). They may experience feelings of isolation, guilt, and shame, and encounter difficulties in preparing for childbirth (4). Therefore, women with a fear of childbirth have various needs that require serious attention from maternal care services (5). Psychotherapy groups have been recognized as an effective method for treating this fear (6). Interventions such as psychosexual education and cognitive-behavioral therapy can help reduce the number of women requesting cesarean sections due to non-medical fear of childbirth (7). Additionally, receiving individualized care during pregnancy and postpartum is crucial for women with tokophobia (8). Schema therapy is a comprehensive approach that combines cognitive theory and developmental concepts. This approach focuses on early childhood experiences and the cognitive schemas derived from them, examining their impact throughout an individual's life (9). Schema therapy aims to identify and address maladaptive patterns in cognitive, emotional, and behavioral aspects (10). Further research is needed to more precisely determine the effectiveness of schema therapy in treating tokophobia (1, 11). Therefore, the present study aimed to answer the question of whether the effectiveness of general schema therapy and schema therapy specifically tailored for women with tokophobia is the same in reducing the symptoms of fear of childbirth in primiparous women in Isfahan? Methods: This study was a semi-experimental research with a control group, including pretest, post-test, and follow-up, conducted in the population of primiparous women with tokophobia in Isfahan in the year 2023. Following Kok's recommendation (2002) for sample size determination in experimental research (12), 45 subjects were purposefully selected and, after matching based on the criteria for entering the study, including obtaining a minimum score (30 and above) on the Tokophobia Questionnaire (13), no history of fetal abortion and curettage, and absence of more than three sessions of absence from treatment sessions, were randomly assigned to three 15-person groups: general schema therapy, schema therapy specifically tailored for women with tokophobia, and the control group. In this research, the control group, general schema therapy group, and specifically tailored schema therapy group were replaced by the standard general schema therapy. The general schema therapy group participated in 12 group training sessions, each lasting 60 minutes, according to the protocol developed by Young et al. (2003) (14). The specifically tailored schema therapy group for women with tokophobia also underwent 12 one-hour sessions of schema therapy developed based on the needs of pregnant women with tokophobia. It is worth mentioning that the specifically tailored schema therapy package for women with tokophobia was developed based on the process of development and initial trial reliability and relied on credible sources. The agreement reached by the judges regarding the structure of treatment, duration of treatment, length of each session, content adequacy, and practicality of this treatment was 82.0. Also, in a pilot study on a group of eight, the executive and operational reliability and practicality of the specifically tailored schema therapy package for women with tokophobia were examined and confirmed. To observe ethical principles, the research was approved by the Research Committee of the University with the ethics code IR.IAU.KHUISF.REC.1401.028, and the clinical trial code IRCT20211229053565N1 was obtained. The collected data were analyzed using repeated measures analysis of variance and the SPSS-28 statistical software. The Stoll et al. (2016) 10-item questionnaire was used to measure tokophobia (15). Higher scores on this questionnaire indicate higher fear of childbirth, and lower scores indicate lower fear of childbirth. The reliability of this tool was estimated using the Cronbach's alpha method, and it was 79.6 for the entire questionnaire and 86.0 for the fear of pain and complications subscale, and 82.6 for the fear of physical changes subscale (16). Results: Examination of demographic data showed no significant differences in age and duration of marriage in the research groups. The assumption of normality in the ShapiroWilk test for tokophobia scores was not significant (p>0.05), and the distribution of the present variables was normal. The calculated F value in the pre-test, post-test, and follow-up stages was not significant. The results of the analysis of variance with repeated measures showed that general schema therapy and schema therapy specifically tailored for women with tokophobia had a significant effect on reducing tokophobia severity in primiparous women with tokophobia. Therefore, for the comparison of research groups, the Bonferroni test for pairwise comparison of groups also showed a significant difference between the experimental groups and the control group (p<0.05), but there was no significant difference between the general schema therapy and specifically tailored schema therapy groups for women with tokophobia (p>0.05). Conclusion: Based on the findings of the research, it can be concluded that both schema therapy and schema therapy specifically tailored for women with tokophobia have a significant impact on reducing the severity of tokophobia symptoms in primiparous women in Isfahan. These results indicate that the use of these two therapeutic approaches can help improve the condition of women with tokophobia and have a positive effect on reducing the fear of childbirth. Additionally, the results show a significant difference between the treatment groups and the control group, suggesting that therapeutic intervention can be more effective in reducing tokophobia severity in primiparous women compared to no intervention. However, no significant difference was observed between the general schema therapy and specifically tailored schema therapy groups. This may indicate that both therapeutic approaches have acted similarly in reducing the severity of tokophobia in women with this disorder, and no significant noticeable difference was observed between these two methods. Overall, the results indicate that both general schema therapy and specifically tailored schema therapy can be effective in reducing the severity of tokophobia in primiparous women. In this regard, it can be stated that schema therapy, by reducing ineffective coping mechanisms, allows patients to effectively manage their phobias related to childbirth and pregnancy. These results can serve as a guide for designing and implementing therapeutic programs to improve the condition of individuals with tokophobia. [ABSTRACT FROM AUTHOR]

Aim: This systematic review and meta-analysis study aimed to investigate the effects of psychoeducation on fear of childbirth and postpartum outcomes. Methods: Literature search was conducted in PubMed, CINAHL, Scopus and Science Citation Index (Web of Science) until December 2022. This work is based on the recommendations of the Cochrane guidelines. The data were analyzed using the Review Manager computer program (Version 5.3). Results: Eight randomized controlled trials were included in the meta-analysis: all 8 studies were combined for fear of childbirth. In the meta-analysis, it was seen that psychoeducation decreased the fear of birth (MD: 10.18 95% CI: 9.32 to 11.05, Z = 23.09, p < 0.00001) in pregnant women, when the anxiety and depression rate (SMD: -0.36 95% CI: -0.57 to -0.15, Z = 3.34, p=0.0008) were examined, it was seen that there was no difference in depression, it decreased the cesarean section (SMD: -0.35 95% CI: -0.49 to -0.22, Z = 5.19, p

Objective: Childbirth is a complex process with various dimensions including physical, psychological, emotional, social, and cultural aspects. The study intended to assess the effectiveness of Nurse led FALCI (Fear and Apprehension related to Labour or Childbirth Improving) Intervention in reducing childbirth fear among pregnant women. Materials and methods: A quasi-experimental study was conducted among 115 pregnant women (selected through purposive sampling) at antenatal OPD of tertiary care hospital of Bhopal. Data was collected using Wijma Delivery Expectancy Questionnaire (DEQ) and self-structured questionnaire on socio-demographic and clinical variables. The intervention (FALCI) was carried out in two phases, each lasting for 30 minutes conducted at week 3-4 and week 5-6 and information booklet was provided for reinforcement. The data was analysed using two-way repeated measures mixed ANOVA (within group and between groups). Results: Findings revealed that most of the pregnant women in both experimental (68.5%) and control (90.2%) group had high level of childbirth fear. Post-intervention data revealed mean of pretest, posttest 1 and posttest 2 were 73.85, 46.94 and 37.90 in experimental group and the mean of pretest, posttest 1 and posttest 2 were 75.49, 72.59 and 72.67 in control group respectively and found that there is significant difference in childbirth fear (within group, F value=114.69, p<0.001 in experimental group and F =0.575, p=0.564 in control group) and between groups (F value= 81.52, p value <0.001). However, no significant association was found between childbirth fear and sociodemographic/clinical variables. Conclusion: The study findings revealed that Nurse led FALCI intervention was effective in reducing childbirth fear among the pregnant women and it is recommended that such intervention must be planned at all levels and implemented as routine protocol in maternity services. [ABSTRACT FROM AUTHOR]

A body of evidence has consistently showed that fear of childbirth (FOC) is associated with mother and child health. However, the psychological mechanisms underlying the FOC have not been well-elaborated. The aim of the study is to investigate the potential associations of FOC with discomfort intolerance and distress tolerance which are causally involved within anxiety and somatization. A hundred and three pregnant women in the third trimester who did not have an indication for a cesarean section, or a severe obstetric problem participated in the study. Participants completed a socio-demographic questionnaire, the Wijma Delivery Expectancy/ Experience Questionnaire Part A (W-DEQ), Discomfort Intolerance Scale (DIS), and Distress Tolerance Scale (DTS). The mean age for the sample was 28.17 (SD ± 5.57). Logistic regression analyses and a multiple indicators multiple causes (MIMIC) model were performed. 33% of pregnant women were clinically fearful (W-DEQ ≥ 85). Logistic regression showed that maternal age, age of spouse, physical health problems, partner violence and preferred mode of delivery significantly contributed to FOC. The MIMIC model indicated that discomfort intolerance was a significant risk factor and distress tolerance capacity was a protective factor for severe FOC. Although there has been a burgeoning research interest on psychological mechanisms of FOC, the previous findings are limited. The current data presented that intolerance to distress and distress tolerance which are indicators of emotional regulation should be taken into consideration in developing counselling interventions in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Childbirth is a complex process with various dimensions including physical, psychological, emotional, social, and cultural aspects. The study intended to assess the effectiveness of Nurse led FALCI (Fear and Apprehension related to Labour or Childbirth Improving) Intervention in reducing childbirth fear among pregnant women. Materials and methods: A quasi-experimental study was conducted among 115 pregnant women (selected through purposive sampling) at antenatal OPD of tertiary care hospital of Bhopal. Data was collected using WIJMA Delivery Expectancy Questionnaire and self-structured questionnaire on socio-demographic and clinical variables. The intervention (FALCI) was carried out in two phases, each lasting for 30 minutes conducted at week 3-4 and week 5-6 and information booklet was provided for reinforcement. The data was analysed using two-way repeated measures mixed ANOVA (within group and between groups). Results: Findings revealed that most of the pregnant women in both experimental (68.5%) and control (90.2%) group had high level of childbirth fear. Post-intervention data revealed mean of pretest, posttest 1 and posttest 2 were 73.85, 46.94 and 37.90 in experimental group and the mean of pretest, posttest 1 and posttest 2 were 75.49, 72.59 and 72.67 in control group respectively and found that there is significant difference in childbirth fear (within group, F value=114.69, p

Fear of childbirth (FOC), or tokophobia, can influence several medical and obstetric variables, and is a significant predictor of maternal and mental health outcomes and birth experiences. Current practice in the UK does not include initial screening for tokophobia, rather, assessment and support occur under extreme circumstances e.g. maternal requests for caesarean sections or pregnancy termination requests in order to avoid childbirth. Moreover, while there are several candidate outcome measures for FOC, none have been evaluated in terms of their perceived suitability by specialist practitioners within perinatal healthcare pathways. The present study explores the perceived barriers and facilitators reported by health professionals working within the maternity and mental health services for the use of FOC candidate outcome measures. Evaluated measures included the Fear of Birth Scale, the Oxford Worries about Labour Scale, The Wijma Delivery Expectancy Scale, the Slade-Pais Expectations of Childbirth Scale the Tokophobia Severity Scale. The Tokophobia Severity Scale, followed by the Slade-Pais Expectations of Childbirth Scales were the most favourable scales selected for use according to clinicians. The identification of preferred scales and how they can be used in the local maternity system is a step towards the application of these consistently in clinical practice, to aid in the identification and assessment of FOC. The use of the correct tool at each stage of contact with the local maternity system will improve clinician confidence in the identification of FOC and facilitate the efficient implementation of treatment and support through the development of pathways of care. [ABSTRACT FROM AUTHOR]

• DSTI – Dual Session Tokophobia Intervention. • Novel Cognitive Behavioral Therapy (CBT) for Tokophobia in the third trimester. • Structured protocol administered by nurses. • Tokophobia case study. Tokophobia is a debilitating, relatively prevalent, and undertreated anxiety disorder, which can lead to prenatal, natal, and postpartum adverse effects. This article provides an outline of the Dual-Session Tokophobia Intervention (DSTI), an ultrashort exposure-based cognitive behavioral therapy (CBT) protocol that can be delivered by non-mental-health professionals to women in the third term of pregnancy. The detailed description of the intervention is illustrated by a case study that is part of an ongoing clinical trial, targeting the specific needs of women suffering from Tokophobia near term. DSTI is carried out in two sessions (for a total of 4 hours) with a 1-week interval in between. The intervention protocol presented in this article, to the best of our knowledge, is the first to offer treatment specifically for women near term. It aims to decrease anxiety and provide women and their newborns with better obstetric and psychiatric outcomes. The patient presented was screened by the Fear of Birth Scale and a Structured Clinical Interview for DSM Disorders. She indicated her Subjective Units of Distress on a list of specific fears related to childbirth, before and after the intervention. Following treatment, the patient showed a 70% decrease in SUDS, a cessation of avoidance and information seeking behaviors, a short labor duration and a subjective experience of being able to calm herself during a difficult birth and concentrate on the delivery process. Six weeks postpartum there were no signs of depression or PTSD. [ABSTRACT FROM AUTHOR]

Aim: Although there are some studies examining the effects of psycho-education on fear of childbirth and outcomes in the postpartum period, high-quality evidence is lacking. This systematic review and meta-analysis study aimed to evaluate the effects of psycho-education on fear of childbirth and postpartum outcomes. Methods: The literature search was completed by a comprehensive and systematic search of the PubMed, CINAHL, Scopus and Science Citation Index (Web of Science) databases until December 2022. Outcome data including the effect of psycho-education on fear of childbirth, labor and birth outcomes were collected for analysis. In the preparation of the systematic review and metaanalysis, the guidelines in the Cochrane Interventions Manual of Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) were based on the recommendations of the guidelines followed. Data were analyzed using the Review Manager computer program (Version 5.3). Cochrane risk-of-bias tools were used in the quality assessment of the studies. Results: Eight randomized controlled trials were included in the meta-analysis: all 8 studies were combined for fear of childbirth. In the meta-analysis, it was seen that psycho-education decreased the fear of birth (MD: 10.18 95% CI: 9.32 to 11.05, Z = 23.09, p < 0.00001) in pregnant women when the anxiety and depression rate (SMD: -0.36 95% CI: -0.57 to -0.15, Z = 3.34, p=0.0008) were examined, it was seen that there was no difference in depression, it decreased the cesarean section (SMD: -0.35 95% CI: -0.49 to -0.22, Z = 5.19, p<0.00001) rate and increased the self-efficacy (SMD: 0.38 95% CI:0.25 to 0.51, Z =5.58 p <0.00001) rate. Conclusion: This study provides sufficient evidence that psycho-education is effective in reducing fear of childbirth, anxiety, and cesarean section rates, while increasing self-efficacy. [ABSTRACT FROM AUTHOR]

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ABSTRACT OBJECTIVE: To explore the relationship between tokophobia, neuroticism and mental health; and to examine the role of neuroticism as a moderator between tokophobia and mental health. METHODS: This cross-sectional study was conducted from September, 2019, to January, 2020, at different hospitals. Three instruments Eysenck Personality Questionnaire (EPQ), Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), and The Wajima Delivery Expectancy Questionnaire (WDEQ) were administered on 100 women along with a demographic sheet to collect data and were analyzed using SPSS V 23. RESULTS: Results showed that tokophobia had a significant positive relationship with neuroticism and significant negative relationship with mental health ({β = -0.23, t = -2.20, p = 0.030}). Neuroticism also predicted Mental health {β = -0.51, t = 5.45, p = 0.001} and create 22% in it {ΔR2 = 0.22, ΔF (1,97) = 29.72, p = 0.001}. The interaction of tokophobia and neuroticism significantly predicted mental health {β = -0.17, t = 2.85, p = 0.48} and about 30% change {ΔR2 = 0.30, ΔF (1,96) = 3.42, p = 0.048} in mental health. Neuroticism significantly moderates the relationship between tokophobia and mental health in negative direction. Residential areas do not have significant differences on neuroticism, tokophobia and mental health among primigravidas. CONCLUSION: Primigravida women with neuroticism personality have higher tendency to develop tokophobia and both significantly affect mental health of pregnant women.

Intense fear of childbirth by expectant women is called tokophobia. Because there are no qualitative studies targeting women with an intense fear of childbirth in Japan, it is unknown whether there is any link between the type of fear of objects/situations among tokophobic women and their psychological/demographic background. Furthermore, there is no available summary of the lived experience of Japanese women with tokophobia. This study aims to identify the intensity patterns of various types of fear among the participants and summarize the lived experience of having intense fear of childbirth. A qualitative descriptive study was conducted using a semi-structured interview. Pregnant women with an intense fear of childbirth participated in individual interviews facilitated by a psychiatrist and a midwife. Audio recordings of the interviews were transcribed and analyzed using a content analysis approach. The number of participants was ten. The types of feared objects varied individually and these were categorized as being related to either prospective or retrospective fear. The participants' experiences were grouped into three categories: difficulty in daily life, preoccupied negative expectation towards childbirth, and psychological adaptation to the upcoming childbirth. The results imply that women with tokophobia continuously suffer from fear in their daily life; hence, a special approach is needed to detect and reduce their fear. [ABSTRACT FROM AUTHOR]

Background and objectives Childbirth fear, which has been argued to have an adaptive basis, exists on a spectrum. Pathologically high levels of childbirth fear is a clinical condition called tokophobia. As a chronic stressor in pregnancy, tokophobia could impact birth outcomes. Many factors associated with tokophobia, including inadequate labor support, were exacerbated by the COVID-19 pandemic. Methodology We used longitudinally collected data from a convenience sample of 1775 pregnant persons in the USA to evaluate the association between general and COVID-19 pandemic-related factors and tokophobia using the fear of birth scale. We also assessed associations between tokophobia, low birth weight and preterm birth when adjusting for cesarean section and other covariates among a subset of participants (N = 993). Results Tokophobia was highly prevalent (62%). Mothers who self-identified as Black (odds ratio (OR) = 1.90), had lower income (OR = 1.39), had less education (OR = 1.37), had a high-risk pregnancy (OR = 1.65) or had prenatal depression (OR = 4.95) had significantly higher odds of tokophobia. Concerns about how COVID-19 could negatively affect maternal and infant health and birth experience were also associated with tokophobia (ORs from 1.51 to 1.79). Tokophobia was significantly associated with increased odds of giving birth preterm (OR = 1.93). Conclusions and implications Tokophobia increases the odds of preterm birth and is more prevalent among individuals who are Black, have a lower income, and have less education. Tokophobia may, therefore, be an underappreciated contributor to inequities in US birth outcomes. The COVID-19 pandemic likely compounded these effects. [ABSTRACT FROM AUTHOR]

Purpose: Tokophobia is a manifestation of severe anxiety that causes fear for women. As a result, women tend to avoid having children and pregnancy due to their fear of childbirth, despite their great interest in having children and the beauty of motherhood. The present study aimed to examine the relationship between Vaginismus, Dysmenorrhea, and social support and tokophobia through the mediation of childbirth self-efficacy. Material and Methods: The present study was a cross-sectional descriptive correlational study. The statistical population of the study consisted of all pregnant women referred to Taleghani Hospital. Out of the population, 146 pregnant women were selected as the research sample using the availability sampling technique. Research data were collected using the Tokophobia Questionnaire (2021), Multidimensional Vaginal Penetration Disorder Questionnaire (MVPDQ), Moos Menstrual Distress Questionnaire, Perceived Social Support (MSPSS), and Lowe's Childbirth Self-Efficacy Questionnaire. The collected data were then analyzed using the Smart PLS software and statistical methods of correlation and path analysis. Results: The results showed that there was a significant relationship between, vaginismus with child birth self-efficacy (B=0.341, t=4.145, p<0.001) and social support with child birth self-efficacy (B=0.205, t=2.591, p<0. 01), but there wasn't relationship between dysmenorrhea with child birth self-efficacy(B=0.035, t=0.293, p>0. 05) and child birth self-efficacy with tokophobia (B=0.210, t=1.497, p>0. 05). Conclusion: According to the fitting indices of the model, it can be concluded that the tokophobia model has an weak fit on the basis of vaginismus, dysmenorrhea, and social support and mediating role of child birth self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Fear of childbirth (FOC) is a common and complicated problem among nulliparous pregnant women. Objectives: The aim of this study was to compare the effects of expressive writing and neutral writing on FOC in nulliparous pregnant women. Methods: A randomized controlled trial was conducted on 90 nulliparous pregnant women referred to selected comprehensive health centers in Isfahan for prenatal care from May 1 to September 30, 2021. The participants were recruited consecutively and randomly allocated to two groups to perform either expressive writing or neutral writing at home for 20 min daily for 7 days. Before and after the intervention, FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire. Paired t-test, independent t-test, and Chi-square were used for statistical analysis. Results: The mean age of pregnant women was 29.93 ± 5.20 and 29.18 ± 5.65 years in the usual and expressive writing groups, respectively. The mean FOC scores of the women in the neutral writing and expressive writing groups were 36.31 ± 7.35 and 35.96 ± 6.80, respectively, at baseline (P = 0.81) and changed to 34.98 ± 8.18 and 31.58 ± 7.99, respectively, at the end of the study (P < 0.04). The paired t-test showed that the mean FOC score of the expressive writing group decreased significantly at the end of the study (P < 0.001), whereas it did not change significantly in the neutral writing group (P = 0.11). Conclusion: Expressive writing can reduce FOC in nulliparous pregnant women and can be used as an effective, low-cost, simple, and accessible method.

To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK. Fear of childbirth (FOC) can have a significant impact on a woman's view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women's needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability. A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers. The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK. A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the effect of hypnosis applied during the antenatal period on labor pain and fear in pregnant women. Methods: 100 pregnant women who were administered hypnosis and 100 women who were not, were included in this prospective descriptive study, between January and June 2019. The Wijma Birth Expectation/Experience Scale Version A Questionnaire was applied to the pregnant women at the end of hypnosis, and at the same week to the pregnant women who were not hypnotized, and the results of both groups were compared. Results: Total Wijma scores of the hypnotized group were statistically significantly lower (the higher the score, the higher the fear), while the pain perception scores at birth were significantly higher (negatively loaded question) (p<0.05). It was concluded that the expectation of pain in labor changed significantly after hypnosis and the fear of childbirth decreased significantly. Conclusion: Considering the positive effect of hypnosis on the fear of childbirth, it should be emphasized that hypnosis, which is an important alternative method in our country where the rate of birth fear and related cesarean section is gradually increasing, has a calming effect and changes the negative perceptions of pregnant women about childbirth. [ABSTRACT FROM AUTHOR]

In recent decades, the rate of caesarean deliveries has increased worldwide. The reasons for this trend are still largely misunderstood and controversial among researchers. The decision often depends on the obstetrician, his beliefs and experience, the characteristics of the patients, the hospital environment and its internal protocols, the increasing use of induction of labor, the medico-legal implications, and, finally, the mother's ability to request delivery by caesarean section without medical indication. This review aims to describe the reasons behind the increasing demand for caesarean sections by patients (CDMR) and strategies aimed at reducing caesarean section rates and educating women about the risks and benefits of CS. [ABSTRACT FROM AUTHOR]

Abstract Background Fear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies. We aimed to investigate predictors of FOC and normal vaginal birth among postpartum women who had planned for a normal vaginal birth. Methods This cross-sectional study was conducted in 2019 with postpartum women during the first 24 h after the birth. A sample of 662 women, selected using a convenient sampling method, filled out the questionnaire composed of socio-demographic and obstetric questions and the Wijma Delivery-Expectancy Questionnaire (W-DEQ). We used multiple logistic regression analyses to determine predictors of FOC and normal vaginal birth. Results The percentage of women with mild (score ≤ 37), moderate (38–65), high (66–84), severe (85–99), and intense FOC (score ≥ 100) were 7.9, 19.5, 40.9, 21.1, and 10.6% respectively. Predictors of intense FOC were age

Fear of vaginal birth is a very common phenomenon among women and may significantly impact maternal-infant health. The goal of this study is to investigate how Cognitive-@Behavioral Therapy (CBT) has been applied in cases of fear of childbirth and assess the efficacy of such interventions. A systematic review of these practices was made using the BVS Brazil, Scopus, and PubMed databases, from February to April 2019. After analyzing the inclusion and exclusion criteria, a total of six full studies were selected as the final sample for this research. Therapeutic techniques such as cognitive restructuring, exposure, and mindfulness have proven to be important means of developing a less catastrophic perception of childbirth along with greater self-confidence in the abilities to cope with labor. The review led to the conclusion that CBT does have the potential to treat fear of childbirth. [ABSTRACT FROM AUTHOR]

There is increasing evidence shows that fear of childbirth (FOC) may have short- and long-term adverse effects on mothers and babies if left untreated. The childbirth process is an experience with many dimensions, multifaceted, and unique for each woman, still strongly influenced by the social-cultural context in which women belongs. To identify and explore the factors contributing to the fear of childbirth among recently delivered women of Pune city, India. The study used a qualitative study approach. A total of 15 in-depth interviews were conducted with women who have recently given birth in maternity hospitals. Interviews were conducted using an interview guide (open ended-questionnaire). Interviews were audio-recorded. The participants were called into a separate room for the interview; full privacy was given to the interviewees, thus making a safe and reliable environment. All collected interviews were transcribed and analyzed. Axial coding was used to develop codes into major themes contributing to FOC were derived. Seven major themes emerged from the analysis of the transcribed interviews. The seven major themes are fear related to the child, fear of parenthood, fear due to mode of delivery, negative pregnancy/delivery experience, psychological aspects attributed to fear of pregnancy, fear of pain, and social background. FOC occurs in most of pregnant women irrespective of parity. The determinants of FOC are influenced by women context; thus, variation in factors of FOC is observed. The FOC related factors show the complex interconnection between them, and it may vary from woman to woman and settings to settings concerning women context. [ABSTRACT FROM AUTHOR]

Abstract Background Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. Methods Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. Results All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. Conclusions Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.

Background & Aim: Tokophobia was introduced as a psychiatric disorder for the first time in 2000. The purpose of this study is to answer four questions: What is tokophobia and how does it occur? What is the global prevalence of tokophobia? What are the symptoms of tokophobia? and what are the strategies for the control and treatment of tokophobia? Methods & Materials: This systematic review was conducted by searching articles in English and Persian published between January 2000 and January 2018 on international databases; PubMed, Scopus, Web of Science, Google Scholar, Science Direct, and domestic databases; Magiran and SID, along with a manual search in resources. Results: After reviewing 151 articles, finally 16 were included in the study. The results indicate that tokophobia is a severe and pathological fear of childbirth. In the categorization of psychiatric disorders, it is classified as a specific phobia based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The etiology of tokophobia is multifactorial, and its prevalence in pregnant women was reported around 14 percent among 18 countries. The signs and symptoms of the disorder are insomnia, crying, restlessness, depression, anxiety and severe worry about childbirth. Psychological strategies, cognitive behavior therapy and medication have been proposed to reduce the fear of childbirth in women in different studies. Conclusion: As a guide, these results can assist the healthcare team members to recognize and screen at-risk women as well as to perform nursing interventions and psychotherapy in the prenatal and delivery stages.

Tokophobia is an overwhelming fear of pregnancy and birth that can lead to severe mental health difficulties in the perinatal period. The condition can be experienced by men as well as women and has implications for physical and mental health wellbeing in pregnancy and the postnatal period. Individuals with tokophobia are likely to have experienced previous traumatic events, which can trigger the condition and are also vulnerable to experiencing traumatic stress. This article proposes an adapted psychologically informed trauma model to help health professionals to understand and support pregnant women (and men) living with this condition. The aim of this is to raise awareness of the condition, as well as offer a guide for professionals to support and validate those living with this condition, as well as help them to feel safe and secure with the professional supporting them. It is hoped that this will lead those with tokophobia to experience a sense of safety, calmness, self-efficacy, connectedness and hope in working with professionals supporting them. This may, in turn, lead to them feeling more empowered and connected to becoming a parent and in planning their birth journey for those that are pregnant and living with this condition. [ABSTRACT FROM AUTHOR]

Background: Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC. Methods: Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations. Results: After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90). Conclusions: Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made. [ABSTRACT FROM AUTHOR]

Aim of the study: The aim of the study was to analyze the influence of tokophobia on delivery solution by Caesarean section. The number of deliveries solved by Caesarean section has increased significantly in recent years. In Poland, it has almost doubled since 2000 (from 18.1% to 37%) Research methods: A survey was used in the study. 25 first-born girls and 25 multi-rivers took part, the selection criterion was delivered by caesarean section. Results: The fear of giving birth was the cause of caesarean section in 12 of the 25 primigravidas and 12 of the 25 multigravidas. Conclusion: Fear of childbirth may be a very important issue related to planning the delivery method.

In recent decades, the rate of caesarean deliveries has increased worldwide. The reasons for this trend are still largely misunderstood and controversial among researchers. The decision often depends on the obstetrician, his beliefs and experience, the characteristics of the patients, the hospital environment and its internal protocols, the increasing use of induction of labor, the medico-legal implications, and, finally, the mother’s ability to request delivery by caesarean section without medical indication. This review aims to describe the reasons behind the increasing demand for caesarean sections by patients (CDMR) and strategies aimed at reducing caesarean section rates and educating women about the risks and benefits of CS.

Background: Fear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies. We aimed to investigate predictors of FOC and normal vaginal birth among postpartum women who had planned for a normal vaginal birth.Methods: This cross-sectional study was conducted in 2019 with postpartum women during the first 24 h after the birth. A sample of 662 women, selected using a convenient sampling method, filled out the questionnaire composed of socio-demographic and obstetric questions and the Wijma Delivery-Expectancy Questionnaire (W-DEQ). We used multiple logistic regression analyses to determine predictors of FOC and normal vaginal birth.Results: The percentage of women with mild (score ≤ 37), moderate (38-65), high (66-84), severe (85-99), and intense FOC (score ≥ 100) were 7.9, 19.5, 40.9, 21.1, and 10.6% respectively. Predictors of intense FOC were age < 30, primiparity, low maternal satisfaction with pregnancy, and a low level of perceived marital satisfaction. Overall, 21.8% of women gave birth by cesarean. Predictors of normal vaginal birth were birth weight < 4 kg, spontaneous onset of labor pain, mother's age < 30, term pregnancy, having a doula, multiparity, satisfaction with husband's support, and overall satisfaction with pregnancy. A high level of perceived marital/sexual satisfaction was a risk factor for cesarean. Mode of birth was not a predictor of postpartum FOC.Conclusions: The rate of severe and intense FOC among this group of postpartum women is high. Our findings highlight modifiable factors for reducing FOC and increasing normal vaginal birth. In designing programs to increase the rate of normal vaginal birth, the following factors should be considered: limiting induced labor, encouraging women to recruit a doula to help them at labor, facilitate husband's attendance throughout antenatal/intrapartum, and postnatal care to support his wife, and pay attention to women's common misunderstandings about the effect of vaginal birth on marital/sexual relationship. Our findings indicate that seeking novel ways to promote marital/sexual satisfaction and helping women to have a smooth, hassle-free pregnancy may contribute to a reduction in the rate of the FOC. [ABSTRACT FROM AUTHOR]

Context: Tokophobia is an intense fear of childbirth that may result in considerable outcomes. This phenomenon may also be observed in fathers. However, studies are infrequent on tokophobia frequency and its related factors in fathers. Therefore, this study aimed to address tokophobia in fathers. Evidence Acquisition: A comprehensive literature search was performed in databanks such as Ovid and Google Scholar, as well as electronic databases including PubMed, ProQuest, Web of Science, Science Direct, Magiran, Scientific Information Database (SID), and Barakat (IranMedex), without time limit. Articles were published between 1988 and 2020. Results: Initially, 150 studies were recruited, and finally, 55 of themremained for the final appraisal after omitting unrelated studies. The findings from related studies were organized as the epidemiology of tokophobia inmen, biopsychosocial etiology, clinical signs, diagnosis, treatment, and prognosis of tokophobia in men. Considering the tendency of fathers to hide tokophobia, providing suitable knowledge and support from health providers can probably retain the trust in this population and help them cope with tokophobia. Conclusions: During pregnancy, fathers may suffer from fear of childbirth that can impact their health and abilities. Thus, during counseling and prenatal care, the providers should pay attention to fathers. [ABSTRACT FROM AUTHOR]

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary. [ABSTRACT FROM AUTHOR]

Objective: Severe fear of childbirth (tokophobia; TP) is an understudied and under‐recognised phenomenon that has significant implications for maternal mental health during pregnancy, labour and delivery. The few existing measures of TP are limited by lengthy formats, difficulty scoring and a narrow definition of the TP construct. Method: The current study examined the psychometric properties of a newly developed self‐report scale, the Tokophobia Severity Scale (TSS), in a sample of 122 female participants. Results: The final measure consisted of 13 items. The scale demonstrated a unidimensional structure and items demonstrated excellent internal consistency (α =.93) and adequate convergent validity with the Wijma Delivery Expectancy/Experience Questionnaire‐Version A. Conclusions: The findings provide preliminary evidence to suggest that the TSS is a brief, valid and reliable measure that may be used in the future to identify women with TP who may benefit from psychological and supportive interventions prior to delivery. [ABSTRACT FROM AUTHOR]

Background: Maternal health experts opine that poor control of labour-pain could result in traumatic childbirth experience which could lead to tokophobia. Aim: This study examined the association between perceived labour-pain and tokophobia amongst mothers who had normal vaginal birth in University of Port Harcourt Teaching Hospital Nigeria. Methods: A cross-sectional design was used. A sample size of 218 randomly selected birthing mothers was examined for the study. Fear of childbirth and numeric analogue scale for labour-pain interview questionnaires designed by the research team were used for data collection. Data were collected through face-to-face interview of consenting postnatal mothers at 24-36 h after labour. Collected data were analysed using descriptive and inferential statistics at P < 0.05. Results: About 85.3% of the respondents had severe perceived labour-pain. Only 2.8% of the respondents suffered moderate tokophobia. Occupation was significantly associated with tokophobia (P = 0.047) and homemakers (unemployed women) were more likely to suffer tokophobia. Perceived labour-pain, parity and age were not significant determinants of tokophobia (P > 0.05). Conclusion: Severe perceived labour-pain is widespread, whereas tokophobia is not very common in South-Southern part of Nigeria. Tokophobia was predicted by unemployment but not perceived labour-pain, parity and age. Midwives and other obstetric care givers should incorporate mental health services into prenatal care of unemployed women and advocate for adequate analgesia during labour to further reduce perceived labour-pain. [ABSTRACT FROM AUTHOR]

When a caesarean section is performed on a singleton pregnancy when there is no clinical indication, this is deemed a maternal request caesarean section (CSMR). The procedure contributes to the ever rising rates of caesarean sections in the UK, as well as the rates associated risks and subsequent financial burden to the NHS. The ethics of exposing these otherwise healthy women to the risks of surgery and the increasing financial strain on our healthcare system becomes complicated with the importance of assessing and managing the patients' psychological well-being and the demand to promote patient choice and autonomy. This article considers the main reasons behind why we encounter CSMRs, while exploring the ethical dilemmas we as obstetricians face. We will also look at ways to manage these women, with suggestions of support and evidence to provide in order for them to make an informed decision. [ABSTRACT FROM AUTHOR]

Background & Aim: Tokophobia was introduced as a psychiatric disorder for the first time in 2000. The purpose of this study is to answer four questions: What is tokophobia and how does it occur? What is the global prevalence of tokophobia? What are the symptoms of tokophobia? and what are the strategies for the control and treatment of tokophobia? Methods & Materials: This systematic review was conducted by searching articles in English and Persian published between January 2000 and January 2018 on international databases; PubMed, Scopus, Web of Science, Google Scholar, Science Direct, and domestic databases; Magiran and SID, along with a manual search in resources. Results: After reviewing 151 articles, finally 16 were included in the study. The results indicate that tokophobia is a severe and pathological fear of childbirth. In the categorization of psychiatric disorders, it is classified as a specific phobia based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The etiology of tokophobia is multifactorial, and its prevalence in pregnant women was reported around 14 percent among 18 countries. The signs and symptoms of the disorder are insomnia, crying, restlessness, depression, anxiety and severe worry about childbirth. Psychological strategies, cognitive behavior therapy and medication have been proposed to reduce the fear of childbirth in women in different studies. Conclusion: As a guide, these results can assist the healthcare team members to recognize and screen at-risk women as well as to perform nursing interventions and psychotherapy in the prenatal and delivery stages. [ABSTRACT FROM AUTHOR]

An increase in the number of women who have fear of birth [FOB] has been reported globally; yet, how these women are identified varies. This study aimed to identify the most effective way of measuring FOB in clinical practice. This paper reports on a prospective cohort study; a core element of an explanatory mixed-methods study. This element explored the appropriateness of measures of anxiety (biomarkers and validated questionnaires) and observed any relationship between anxiety levels and clinical outcomes. A purposive sampling strategy was used. One hundred and forty-eight primigravida, during the 1st trimester, in two tertiary maternity units in England were included. Demographic and baseline data were collected from participants in the first trimester of pregnancy along with FOB scores, and a saliva sample to measure cortisol level. In the third trimester, a second FOBS score, and saliva sample were collected, and the Personal Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were administered to measure depression and anxiety respectively. The FOBS was completed by 148 women in the first trimester and 80 in the third. Using a cut-off of 54, 30/148 (20%) women had a FOB in the first trimester; 21/80 (26%) had a FOB in the third trimester, 15 (19%) of whom also had a FOB in the first. Compared with the first trimester, 51/80 women showed an increase in FOBS score, with 14 scores increasing above and 8 scores decreasing below the cut-off of 54. FOBS scores were not correlated with salivary cortisol in either trimester (first trimester Spearman's ρ=0.08, p = 0.354, n = 144; third trimester ρ=0.12, p = 0.309, n = 71) but they were correlated with PHQ-9 and GAD-7 scores in the third trimester (PHQ-9 ρ=0.53, p = 0.010, n = 23; GAD-7 ρ=0.45, p = 0.033, n = 23) although not sufficiently high enough to demonstrate convergent validity against those measures of depression and anxiety. They were also associated with a previous history of depression but only in the first trimester (p = 0.011). FOBS scores showed considerable variability and a high measurement error, indicating a need for further refinement and psychometric testing. The FOBS is a potentially effective way of measuring FOB in clinical practice and research, but it requires refining. Scores are not related to salivary cortisol levels but are correlated with validated scores for anxiety and depression. An enhanced version of the FOBS could be used in clinical practice to measure FOB. [ABSTRACT FROM AUTHOR]

Background: Recent research has suggested that pretraumatic stress related to a forthcoming predictable traumatic event might exist and that such stress reactions would be a key, 'but largely ignored', aspect of the etiology of Posttraumatic Stress Disorder (PTSD). While it is now acknowledged that childbirth may lead to PTSD, less is known regarding pretraumatic reactions in pregnancy. This study aims to (a) explore the frequency of PTSD, Fear of Childbirth and tokophobia associated with the forthcoming delivery and (b) highlight associated features of pre-traumatic stress symptoms. Methods: At 34 weeks' gestation, a sample of 102 women completed questionnaires assessing anticipated labour pain, fear of childbirth, fear of pain, pretraumatic stress symptoms, perceived social support and depressive and anxiety symptoms. Results: 8.8% of women met DSM-IV-TR criteria for PTSD related to the threatening forthcoming delivery. Fear of childbirth, anticipated labour pain, anxiety, and depressive symptoms were significant predictors of pretraumatic stress intensity. Conclusion: Our results extend prior findings on postpartum PTSD by showing that fear of labour pain is a specific construct, clearly independent from the experience of general pain. Our results suggest that childbirth may be experienced as threatening and traumatic and that this traumatic impact might develop way before the delivery. As a potential traumatic continuum from pre- to posttraumatic stress might exist, further longitudinal studies assessing pre-, peri- and posttraumatic reactions is needed to provide support for this hypothesis. [ABSTRACT FROM AUTHOR]

Fear of childbirth (FOC) is a phobic-like response concerning the prospect of giving birth. FOC can have negative implications for women during pregnancy and can impact their birthing experience. Cognitive processing biases (e.g., difficulty disengaging from threatening information, interpreting ambiguous information as threatening, and preferentially recalling threatening content) have previously been found to maintain general anxiety and low mood. To date, there has been no research assessing these attention, interpretation, and memory biases and their relationship with FOC in pregnant women. Accordingly, in this cross-sectional study, participants who were at least 12 weeks pregnant (n = 116), recruited through a local hospital trust, completed tasks assessing attention (emotional Stroop task), interpretation (scrambled sentences test), and explicit memory (recognition task) biases with materials including FOC-related content. They also completed three separate measures of FOC and measures of low mood, general anxiety, worry, and rumination. We found that a negative interpretation bias (but not attention or explicit memory biases) was associated with higher levels of FOC. These findings indicate that women presenting with higher FOC are more likely to demonstrate negative interpretation biases for ambiguous information relating to childbirth, which may inform research developing interventions to support women presenting with FOC. • Fear of childbirth (FOC) concerns anxiety regarding the process of giving birth. • General anxiety is maintained by cognitive processing biases. • We examined associations between cognitive biases and FOC in pregnant women. • Women completed attention, interpretation, and memory bias tasks, and FOC measures. • Greater negative interpretation bias was associated with higher levels of FOC. [ABSTRACT FROM AUTHOR]

Background providing appropriate care for pregnant women with high or severe fear of childbirth (FOC) is a challenge in midwifery care today. FOC is associated with predisposing anamnestic factors, various sociodemographic and psychosocial characteristics, and may result in serious healthrelated consequences. It is therefore important to establish which interventions may increase a woman's faith in her own ability to cope with labour and birth. Aim to systematically identify and review studies examining interventions for relief of severe fear of childbirth in pregnancy and their underlying conceptual foundation. Methods a systematic literature search was performed following Cochrane Collaboration and PRISMA Statement recommendations. Inclusion criteria were: studies including pregnant women diagnosed with high or severe FOC or who requested a caesarean section due to severe FOC, studies (regardless of design) observing the effect of an intervention addressing FOC, and studies published in English. Publications addressing anxiety or stress were excluded. 377 references were screened by title and abstract. The risk of bias was assessed. Findings 19 articles referring to 15 research projects were included in the analysis. The studies show heterogeneity regarding assessment methods, type, conceptualisation and application of interventions. There is evidence that both cognitive therapy sessions and a theory-based group psychoeducation with relaxation are effective interventions. Key conclusions despite methodological limitations, single or group psychoeducation sessions for nulliparous women or therapeutic conversation during pregnancy (in group or individual sessions) have the potential to strengthen women's self-efficacy and decrease the number of caesarean sections due to FOC. The theoretical validation of an intervention deepens the understanding of psychological processes in women coping with severe FOC. Implications for practice theory-based concepts of care for both antenatal and intrapartum support of pregnant women with high or severe FOC should be developed, piloted, tested, evaluated and implemented within the given healthcare system. Midwives need to be competent to address pregnant women's fears regarding labour and birth in antenatal care. The use of a valid assessment tool to identify the level of FOC in women, even if they do not raise the issue, is recommended in routine antenatal care so that appropriate expert support can be offered. A one-on-one conversation may be feasible for those women unwilling to fill in a questionnaire. Cooperative local networks between midwives, psychologists and obstetricians qualified in psychotherapy should be established to ensure timely and effective care for women with high or severe FOC. [ABSTRACT FROM AUTHOR]

Objectives: Given that prepartum psychiatric symptoms have been reported to be associated with postpartum disorders, focusing on the prepartum period appears of prime importance. The aim of the current study was threefold: (a) to identify the prevalence rates of women suffering from fear of childbirth (FOC) and tokophobia (b) to explore the association between FOC, obstetrical and psychopathological variables and (c) to identify the independent predictors of the intensity of FOC symptoms, FOC and tokophobia.Methods: at 36 weeks’ gestation, 98 women completed questionnaires assessing FOC, pretraumatic stress, fear of pain, depressive and anxiety symptomatology as well as perceived social support. Socio-demographic and gynecological data were also gathered.Results: 22.45% of women reported a probable FOC and 20.41% suffered from a potential tokophobia. Epidural anesthesia (ß = 5.62, p < 0.05), and the intensity of pretraumatic stress symptoms (ß= 0.69, p < 0.05), were independently associated with the intensity of FOC symptoms. Planning a c-section was significantly related to FOC (β = 0.09, p = 0.03). Planning an epidural anesthesia was also an independent predictor of both FOC and tokophobia (β = 1.33, p = 0.03; β = 1.26, p = 0.04, respectively).Conclusions: Given the high rates of FOC and tokophobia highlighted, developing an appropriate preparation to childbirth is of great relevance. Longitudinal studies should be developed in order to provide an in-depth examination of the course of prepartum psychiatric disorders, maintenance of symptoms and their impact on subsequent infant development. [ABSTRACT FROM AUTHOR]

Background: Tokophobia has been defined as a psychological disorder which ranges from insignificant to extreme fear of childbirth. The prevalence of tokophobia in pregnant women is estimated to be 14-20%. There is a sigificant evidence that tokophobia has serious long-term and debilitating adverse effects on both mother and child. The purpose of this study was to review the effect of tokophobia on the health status of mothers and children. Methods: In this review study, the search was conducted among related papers indexed in Google Scholar, PubMed, MEDLINE, Web of Science, ScienceDirect, Scopus, PsycINFO and SID (Scientific Information Database) databases. The used keywords were "tokophobia" "fear of childbirth", "child mental health", "child health", and "mother's health". Articles published from 1995 to 2018 were selected. Of 38 searched articles, after reviewing abstract and full texts, 13 were excluded and in the end, 25 papers were selected for the review. Results: Results were categorized in two main categories: 1. Mother's health consequences: insomnia, increased maternal cortisol level, increased request for cesarean section, longer labor period, antenatal depression, anxiety disorders, increased risk postnatal depression, posttraumatic stress disorder, avoiding further pregnancy or increased interval between pregnancies, increased instrumental birth, stronger need for pain relief and epi¬dural anesthesia, subsequent sterilization, loss of self-control, fear of own incompetence, change in eating habits and physical activity, fear of not being able to take care of baby; 2. Child's health consequences: Decreased child-mother bonding, increased rate of admission to neonatal intensive care unit due to diseases, lower birth weight, and negative effects on the infant’s emotional and social reactions. Conclusions: Given the negative effect of tokophobia on mother and child's health, diagnosis of tokophobia and close liaison with the obstetrician and the comprehensive therapeutic assessment may reduce the morbidity rate associated with tokophobia.