Fear of childbirth (FOC), also referred to as tokophobia, is related to feelings of limited capability in the face of childbirth and affects the pregnant woman’s quality of life. It is more common in nulliparous women but can also be related to earlier traumatic birth experiences. A new study, recenlty published in the Journal of the American Art Therapy Association, compares different treatment options for this condition.
Tokophobia is classified as an anxiety disorder that has been reported in many high-income countries and recent research from Europe has attempted to identify causes of FOC.
The most common explanations reported were:
– Fear of the pain of labor,
– Anxieties about the health of the child,
– Anxiety about the possibility of childbirth complications
– Fear about the loss of control.
It seems that women with experience of sexual abuse and traumatic experience of former birth are more susceptible to FOC. Research has shown that pregnant women with a pronounced FOC run significantly higher risks of birth complications with resulting psychological trauma than women without a pronounced FOC
Treatments aimed at alleviating fear may minimize adverse outcomes associated with severe FOC. However, the evidence base for FOC treatments is not strong.
This study was carried out as an open, randomized, controlled trial with two arms to compare treatment alternatives for severe FOC.
The aim was to examine whether women treated with Art Therapy as an adjunct to midwife-led counseling more often showed reduced FOC than women treated by midwife-led counseling alone.
Painting was offered as a tool for self-reflection, to release feelings they were unable to express elsewhere, to strengthen the process of bonding with their baby, and to initiate the counseling component of Art Therapy. The participants used paper, watercolors, pastel crayons, sponges, and paintbrushes working on an easel. The art therapist was a midwife and first author in this study.
It has been suggested that frequent visits to the mid-wife might decrease anxiety for women with FOC. Through sharing their burden of fear, the women could visualize and access difficult emotions, thereby gaining hope and self-confidence. Cognitive factors are essential in overcoming fear so interventions should focus on the development of cognition. Midwife-led counselling can help women to process previous birth traumas, offer concrete planning of the impending birth, the promise of adequate pain management and strengthen the woman in her decisions about birth. Based on these findings, Art Therapy should not be viewed as replacement therapy to midwife-led counselling but rather as an adjunctive service to help women whose reproductive health may be seriously affected by FOC. Even though Art Therapy was not shown here to be superior to midwife-led counselling, results from the qualitative interviews showed that Art Therapy was highly valued: women described how the intense fear had been relieved with Art Therapy, making them feel stronger and calmer. The women experienced that the images allowed them to express fear in another way, opening up a therapeutic discussion where they could be deeply understood and confirmed by the midwife/art therapist. It offered some women a means of improving their self-reliance, self-confidence and self-awareness, and of enhancing the birth process. Art Therapy enhances dialogue through the patient-therapist relationship and helps increase emotional expression.