Fear of Birth - Dr. Heidi Preis

Question 1

Tokophobia

Answer 1

Extreme fear of giving birth

Question 2

Phobia

Answer 2

Extreme/irrational fear

Question 3

Medicalization of childbirth

Answer 3

Refers to the increase in planned c sections, emergency c sections, birth induction/augmentation (two types of interventions), pain management, etc

However, recent increases in medicalization did not improve birth outcomes –> Fear of birth along with negative emotional stigma of birth has increased due to this medical modernization of birth

Question 4

Birth induction

Answer 4

The woman isn’t giving birth, so professionals want the labor process to start

Question 5

Birth augmentation

Answer 5

When the labor process has started, but it needs a bit of help to move it along

Question 6

Nuclear family

Answer 6

2 parents and their children (“typical” family unit, doesn’t include extended family)
This means that they aren’t directly exposed to birth - must get their sources elsewhere (from friends, social media, etc)

Question 7

ACES

Answer 7

Adverse Childhood Experiences in the form of traumatic life events.

This is an example of a primary fear

Question 8

The Wijma Delivery Expectancy-Experience Questionnaire (WDEQ)

Answer 8

Evaluate fear of childbirth with 33 self-report items using a six levels response scale.
The WDEQ indicates 6 out of 7 dimensions that coincide with qualitative accounts of fear of birth: Feeling fear, negative appraisal (turning out the way people didn’t expect it to), loneliness, lack of self-efficacy, loss of control, and physical harm

Question 9

The Fear of Birth Scale

Answer 9

Evaluate fear of childbirth with self report questions using range of “calm” to “worried” and from “no fear” to “strong fear”

Question 10

Primary/Primiparae

Answer 10

Person has never given birth before

Question 11

Secondary/Multipara

Answer 11

Person has given birth before

Question 12

Examples of Primary Fears

Answer 12

These are fears you have even before your first pregnancy:
- Traumatic life events (ACES)
- Experiences of discrimination or disrespect in healthcare
- Psychiatric or psychological disorders (including prenatal depression or anxiety)

Question 13

Examples of Secondary Fears

Answer 13

These are fears you develop following a previous pregnancy:
- Negative childbirth experience
- Obstetric complications
- Emergency surgical delivery
- Remember that the subjective experience is much more powerful than the objective birth experience

Question 14

Differences in fear of birth based on parity

Answer 14

There is conflicting evidence regarding differences in fear of birth based on parity. Overall fear is higher in primiparae and tokophobia rates are higher in multiparae
(Make sure to review notes and diagram)

Question 15

Mechanisms explaining implications of fear of birth

Answer 15

Behavioral - fear may impact communication, use of pain relief and more acceptance of interventions

Physiological - high fear may increase stress hormones and slow labor progress (ie increased cortisol levels)

It’s a vicious cycle leading to more interventions, objective and subjective negative experiences, and subseqeuntly, higher secondary fear

Question 16

How to treat fear of birth?

Answer 16

• Importance of early detection, especially in the first pregnancy
• Extremem levels require psychological or psychiatric intervention
• High levels can be successfully treated by obstetric providers or integrated teams
• There is evidence for the effectiveness of various types of treatment: psychoeducational, CBT, mindfulness, before/after birth, individual/group, pharmacological/complementary, and more