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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]

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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]

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]

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]

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]

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]

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.

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]

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 & 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]

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.

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. [ABSTRACT FROM AUTHOR]

Tokophobia is a pathological fear of pregnancy and can lead to avoidance of childbirth. It can be classified as primary or secondary. Primary is morbid fear of childbirth in a woman, who has no previous experience of pregnancy. Secondary is morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy. A case of tokophobia with depression who responded to fluoxetine is being described. [ABSTRACT FROM AUTHOR]