Just as with women, paternal response to childbirth and resulting mental-health issues affect offspring and relationships. Some of the symptoms expressed by fathers were similar to PTSD. Antenatal and postpartum support for fathers may also be needed.3

Tokophobia, or fear of childbirth, has been estimated to affect 20% to 50% of women and may be a risk factor for PTSD. In a study by Demšar, the Center for Epidemiologic Studies Depression Scale, a questionnaire which measures current level of depressive symptoms, was the most predictive test for diagnosing fear of childbirth.4


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The researchers found that 53.4% of women interviewed had a moderate fear of childbirth, 23.1% had a high or very high fear, while 1.6% had a fear of childbirth at a pathological level. Of potentially fearful aspects of childbirth, most feared was episiotomy, followed by the sense of having no control. Only 7% of those who had the highest level of fear said that they would choose an elective cesarean section.

In a cross-sectional study by King, PTSD was associated with mode of delivery, maternal complications, support from partner and health professional, perceived safety, and participation in birthing decisions. Prenatal factors associated with PTSD included prior psychiatric history, psychiatric history during pregnancy, and fear of childbirth. 

Ethnicity, income, occupation, infant complications, episiotomy, and trauma history were without association. Variables derived from Ehlers and Clark’s cognitive model best explained variance in PTSD symptoms after childbirth.1

We can provide better postpartum health care by first recognizing who is at risk for PTSD. By staying alert to symptoms of tokophobia, as well as screening for preexisting anxiety and depression,4 we can get timely psychological treatment to patients and reduce conflicts with healthcare providers during delivery. 

Psychological counseling, especially after a stressful delivery, can help prevent future issues. Fathers’ psychological response to traumatic childbirth also should not be overlooked. A model that combines risk and cognitive behavioral factors is the best way to understand PTSD after childbirth.

Addressing these psychological issues during and after delivery can help women, their newborns and family relationships. But addressing these issues and moving towards a more woman-centered care will require training and support. It will require coordination with psychiatric-care providers and improved access to services. As always, good communication is key.

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Reference

  1. King L, McKenzie-McHarg K and Horsch A. “Testing a Cognitive Model to Predict Posttraumatic Stress Disorder Following Childbirth.” BMC Pregnancy Childbirth. 2017;17(1): 32. doi: 10.1186/s12884-016-1194-3
  2. Reed R, Sharman R and Inglis C. “Women’s Descriptions of Childbirth Trauma Relating to Care Provider Actions and Interactions.” BMC Pregnancy Childbirth. 2017;17(1): 21. doi: 10.1186/s12884-016-1197-0
  3. Etheridge J and Slade P. “Nothing’s Actually Happened to Me: The Experiences of Fathers Who Found Childbirth Traumatic.” BMC Pregnancy Childbirth. 2017;17(1): 80. doi: 10.1186/s12884-017-1259-y.
  4. Demšar K, et al. “Tokophobia (Fear of Childbirth): Prevalence and Risk Factors.” J Perinat Med. 2017. doi: 10.1515/jpm-2016-0282 [Epub ahead of print]

 

This article originally appeared on Medical Bag