Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Abstract

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research Abstract Objective: The workshop aimed to discuss and develop a statement on the current state of the evidence and opinion in the field of Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide some recommendations for research. Background: A group of international researchers, clinicians and a service user met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were identified and agreed as the focus of discussion at the meeting. Methods: 12 clinicians and researchers, invited for their known expertise in this or a closely related area (e.g. PTSD) met in Hull, UK to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The meeting focused on identifying areas of uncertainty, key areas of knowledge, emerging research and possible future research within the field. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity Keys points for discussion: Whilst there is a body of work in the field of FoC, work specifically focussed on tokophobia is more recent. It was agreed that there remains a wide range of issues, for which we need further evidence, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding of tokophobia, which gives rise to challenges for robust assessment and the identification of risk factors. An improved understanding of the aetiological and developmental aspects of tokophobia is required to underpin appropriate, effective and evidencebased interventions. The development and evaluation of pathways of care and the interventions these might incorporate, should be a focus of future research to explore the potential for positive outcomes. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research continues to be needed across all areas identified.

A Qualitative Analysis of Feelings and Experiences Associated With Perinatal Distress During the Covid-19 Pandemic

“…As such, interventions aimed at supporting individuals with a known history of pregnancy and birth complications are recommended. Research suggests the unique concept of Childbirth-Related Post-Traumatic Stress Disorder (CR-PTSD), and secondary Tokophobia [58,59] should also be considered. Improved postnatal debrie ng may help to identify problems before subsequent pregnancies, reducing the risk of future perinatal distress.…”

Current Resources for Evidence‐Based Practice, September/October 2021

“…The research on fear of childbirth needs to resolve some key issues. First, there is no clear consensus on the exact criteria for identifying someone as having tocophobia, and in fact, there is no agreement about the underlying concepts of fear of childbirth 13,14 . Having some fear about childbirth, which inherently has a degree of uncertainty, is a natural human response.…”

A new scale for fear of childbirth: the Fear of Childbirth Questionnaire (FCQ)

“…A distinction is made between primary tokophobia (occurring with no prior experience of giving birth) and secondary tokophobia (occurring following the experience of a prior birth; Saisto & Halmesmäki, 2003). It is estimated that approximately one in seven women experience severe FOC (O'Connell et al, 2017); however, this proportion is uncertain given limitations in existing measurement tools and methods of inferring severity (Jomeen et al, 2021;Slade et al, 2020).…”

“…A standardised measure of fear of childbirth has yet to be consistently utilised in the UK. There is a consensus that use of such an instrument could be beneficial (Jomeen et al, 2021;Nilsson et al, 2018); however, currently the only recommendation by the National Institute of Clinical Excellence (NICE) for the recognition of mental health difficulties relating to anxiety is that healthcare staff consider using the 2-item Generalised Anxiety Disorder Scale (GAD-2; NICE, 2014). The GAD-2 reviews women's feelings over the past two weeks and questions how often they have been bothered by feeling nervous, anxious or on edge or bothered by not being able to stop or control worrying.…”

“…Many healthcare professionals use additional measures to try to gain further meaningful information about specific pregnancy or birth-related fears. The limitations of many of these measures have been highlighted, in terms of their utility and acceptability for English speaking UK women (Jomeen et al, 2021;Nilsson et al, 2018;Richens et al, 2018;Slade et al, 2020). The appropriate development of valid UK measures has been hindered by issues like the general lack of clarity around the definition of FOC in the UK (Richens et al, 2018;Rondung et al, 2016) and the cultural sensitivity of otherwise reliable and valid measures after being translated into English (Johnson & Slade, 2002;Toohill et al, 2014).…”