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Fear of parturition was described by Marce (1858) as follows:
“If they are primiparous, the expectation of unknown pain preoccupies them beyond all measure, and throws them into a state of inexpressible anxiety. If they are already mothers, they are terrified of the memory of the past and the prospect of the future.”
It is well known that pregnancy may be a time of considerable anxiety, with symptoms escalating in the third trimester (Lubin et al, 1975). Women in the 1990s still suffer from the fear of death during delivery (Fava et al, 1990). When this specific anxiety or fear of death during parturition precedes pregnancy and is so intense that tokos (‘childbirth’) is avoided whenever possible, it is a phobic state called ‘tokophobia’.
METHOD
Subjects for the study were referred from two sources, obstetricians in the West Midlands and psychiatrists on the mother and baby unit (MBU) at the Queen Elizabeth Psychiatric Hospital in Birmingham.
Twenty-seven women were referred for the study, one declined to be interviewed. The remaining 26 women were seen over a two-year period in their homes by the same psychiatrist, who was not the treating doctor. No structured interview was used in this preliminary study. The authors developed an interview that combined narrative histories with specific direct questions for obtaining information. The authors were investigating trends in presentation and past history that may identify women with tokophobia. They were not investigating an already-established illness pattern. Direct questions were used to elucidate diagnoses of depressive episodes, anxiety disorders and post-traumatic stress disorder (PTSD) using ICD-10 (World Health Organization, 1992). Detailed enquiries were made about the obstetric history, including all pregnancies, contraceptive methods and sexual relationships. The relationship with each baby was examined. Questions about childhood sexual abuse and rape were investigated.
RESULTS
Twelve women were referred by obstetricians, while 14 were new referrals to the MBU. One was contacted after her story appeared in a magazine. Of the 26 women included in the study, 24 women were married and 24 had had all their children with the same partner. The average age at the time of interview was 33 years (range 22-41). Twenty-five of the subjects had children with no evident disability.
Primary tokophobia
Eight women in the sample...